(I am writing this at home, so I am unable to get the images for upload itself. But I will, so you guys can see.)
Because this is my blog, I’m going to talk about radiologists first. I’ve talked to many radiologists over my years as a nurse, but I don’t think I’ve actually SEEN one. Probably I have in the hospital cafeteria, or the parking lot. But I don’t know any faces. This has led me to imagine some flight of fancy ideas about them. I imagine that during medical school, once a person chooses to specialize in radiology, they are attenuated to spend more and more time in the dark, and less and less time in daylight. Kinda like how fish in deep caves become albino over generations. (I understand the whole natural selection over generations thing; these are my ideas and I can have them.) I kind of wonder if daylight causes harm to radiologists. Maybe their skin burns in it. Or sparkles, like girly vampires. And maybe that’s why I don’t see them.
I also think that while they’re being attenuated to increasing darkness, they are also attenuated to finer writing with perfect neutrality. Because they are finding what they know is likely cancer, but they can’t say, “You’re gonna die”. Even if they know patient’s gonna die. They deliver that finding of “a mass”, usually the first finding of cancer and other bad things before workup is done. And the patient will be reading that report. It’s unlike other physician notes that patients have to put more work into obtaining. People want their CXR reports, they want the ultrasound reports, they want the PET scans. Radiologists deliver news very carefully.
That neutrality is also perfect poker face. The radiologist is the guy who, on assessment of patient’s CXR ordered for abdominal cramping in the ER, finds the unusual objects in subject’s rectum. And further, tries to identify said objects….and write the report that writes it in a nonjudgmental, professional way. Come on, that’s funny. Even the patient will find it funny in a few months, maybe years. The ER doc’s note might say, “patient reports accidentally sitting upon light bulb,” but that note has a TONE. ER docs do not have good poker face. They may be very professional while they are with the patient, but you know damn well what they really think of the situation.
Radiologists are medicine’s straight men (and women). I’m sure they’re gathered around the screen in their dark little room deep in the hospital’s bowels, all busting a gut together. But you would never know how hilarious they find that penis-shaped object that traveled up to your sigmoid colon, because the reports never have a tone.
So you know that insurance commercial where the golf commentators are whispering while the kraken emerges from the pool and they continue to whisper their commentary?
That’s what I imagine radiologists are like. Only albino, and with really blue eyes.
I am probably wrong. But this is my mind, and I have my own fun.
So, with that in mind, I finally got around to reading my CT scan interpretation 45 minutes before they let me go home. It said:
“DATE OF EXAM: 06/02/2016, 1846
1. Extensive postoperative changes related to pectus excavatum repair as noted in detail above. Of particular note is the fractured anterior left sixth rib which is displaced and rotated posteriorly indenting the left ventricle.
2. Fluid in the left epicardial space with associated enlarged pericardial lymph nodes secondary to postoperative changes. This may represent reactive lymph nodes with evolving postoperative hematoma or infected phlegmon.
3. Small bilateral pleural effusions and mild compressive atelectasis likely related to surgery.
4. Small hiatal hernia and distal esophageal wall thickening suggest gastroesophageal reflux.
If you are a health care provider and have any questions regarding this or any other Thoracic Radiology report please call 720-848-7129. The Thoracic Radiology reading area location is B.325 AIP2 basement. We are staffed 7:00 AM-5:00 PM Monday through Friday.”
“Of particular note”?!?! “OF PARTICULAR NOTE?!?!” It’s his SECOND SENTENCE. The radiologist is NOTING something. PARTICULARLY. He’s saying there’s a KRAKEN IN THE POOL! I’ve got a BONE FRAGMENT poking into my LEFT VENTRICLE! And EPICARDIAL FLUID?!? Wait, BONE FRAGMENT? Did he say it was displaced and rotated posteriorly indenting my L E F T V E N T R I C L E ?!?!?
That sounds kinda bad.
…And that’s how I dealt with this news, initially. First, blinding panic and then some self-preserving neurotransmitters immediately shut that down. And I started thinking very calmly about who I might need to make amends with. Who I needed to be sure knew that I love them. That Chase and the cats have Mark. And that although I couldn’t do much about flying to India for travel that day, I could certainly dye my hair blue.
I’m sorry if you didn’t follow that last part. Those are two things I’ve always wanted to do: travel through India, blue hair. I don’t have a formal bucket list, because until I read that CT scan, I didn’t feel the need to organize activities I needed to do before I died. Those were two things that came to me.
And. Dude. I have a hiatal hernia? What’s that about? I should google to see if that will go away now, because I’m not actually going to ask any of my doctors about that. Do I know any GI nurses? Hm. That charge nurse on three was really nice, what was her name?
The day I found my useless first husband cheating on me, I was that calm, too. “I am so divorcing you” was my exact thought, delivered in radiologist monotone. I calmly asked the whore he was fucking to excuse me a moment because I needed my car keys back, and I calmly picked up my bank card from the bartender. Hysteria and the throwing and breaking of objects came much later. Old story.
Got a bone poking into my heart. Sounds kinda bad.
It isn’t clear to me how Mark processed this information. He says he knew I needed surgery to fix it right away, but it wasn’t until this last week that he’s said he wants to go get it fixed NOW. He was taking his cues from me, and he doesn’t see the blinding hurricane flash in my head because it happened so fast. And I was sleep-deprived and nauseated and had a stupid PICC line in my left arm, and so calm was what it was.
I’m not the kind of person that denies a thing is happening. But rarely, and on big things (i.e. divorce, this….and honestly, I can’t think of too many examples), I delay.
So I decided to sit on this information.
And get my hair dyed blue.
And think about death.
I did, too, and I’ve got years of goth girl training so I do that well.
Sometimes. Because a large part of my brain was also aware that a) I’ve clearly been living with this since April 21 and I’m not dead yet. And b) this must happen to other of Dr. J’s patients. This MUST have happened when she pushed on my ribs to fix the rib flare, so she has to have patients for whom this occurs. It must be typical. It has to be that this is common. Will the bone set like that? Is there any mechanism that would make it less pointy? No, that doesn’t make any sense, less pointy. Ridiculous. I can’t possibly be the first one. Why didn’t they catch it on the CXR?
And sometimes I thought about it more darkly. So, if I get into a car accident, and the airbag goes off, and that bone shard rips open my ventricular wall….will it hurt? There are no sensory nerves on the heart, which is why people get referred left arm pain. Wow. I should watch for left arm pain. Is hypovolemic shock painful? And I was flipping through my mental rolodex of thousands of patients over the years, looking for faces who had hypovolemic shock. So my kidneys will shut down. Probably long after I care, though, so probably not relevant. At what point will I lose consciousness? Should I be running at all? Since this didn’t just happen yesterday, presumably running won’t make a difference…? Maybe I have epicardial fluid because I’m scratching my heart while I run? Is that a stupid idea? You’d think this might hurt, but it doesn’t. I mean. People have pain with fractured ribs. Why am I not more of a mess?
On and on. For a month I’ve been doing that, on and off. I haven’t been brooding. I had plenty of things to think about. I went back to work a two weeks after discharge, so my head’s been full of work stuff, too. And getting back to living more normally. The dilemma of how to find a good bra, now that my chest measurement is four inches larger. (That’s been harder than you think.) And oh, I loved that bra and I can’t ever wear it again. And laundry. And uremic symptoms my cat is having. Stuff everybody thinks about. Albino radiologists.
But no, I didn’t deal with it beyond talking about it with Mark, and telling Jim, my pulmonologist. His response was, “Does the surgeon know?” And no, she did not. It would be my job to tell her, send her the scan.
And instead of doing that right away, I decided to put my fingers in my ears, and yell, “LA! LA! LA! I CAN’T HEAR YOU!”
Because I am a grown up.
I dealt with the PICC and the infection first. Because I didn’t get a choice in dealing with that. Which is the next part of the story.